The mamma is peculiarly subject to the sar comatous tumour, which is divided by Mr. Aber nethy into the common vascular or organized, the adipose, the pancreatic, the mastoid or mammary, the tuberculated, the pulpy or medullary, and the carcinomatous. Of these various sarcomatous tu mours, the pancreatic, the medullary, and the car cinomatous chiefly affect this gland. The pan creatic attacks the portion situated between the nipple and the axilla, and ultimately involves the axillary glands. It is either quite indolent or very active; and when the latter is the case, there are severe lancinating pains with an inflamed state of the skin, which produce fever and undermine the health. The treatment is to reduce the cutaneous inflammation and constitutional febrile excitement, and then to extirpate the whole mammary gland, together with the axillary. The medullary sar coma or fungus hxmatodes is characterized by its elastic feeling, modulated appearance, some por tions being inflamed, others indolent, and some again natural. The elasticity of this tumour often deceives the practitioner for matter, but it consists of a brain-like substance, cartilage, bone, flesh and blood. This species also involves the axillary glands; occasionally it is as encysted as the com mon wen, and may then be removed by the scalpel with every chance of success.
The carcinomatous sarcoma, or scirrhus, or oc cult cancer, attacks this more frequently than any other gland, and is characterized by an unequal knotted hardness, diminished bulk, and a puckering or depressed appearance of the nipple, while the skin remains in a natural state. These phenomena constitute the indolent state of the scirrhous mamma, but when it assumes the malignant disposition, there are most acute lancinating pains, the skin acquires a purple hue in some spots, and the veins of the skin become enlarged and more or less varicose, and is then termed occult cancer. Whenever ulceration takes place, it is denominated open cancer, which gene rally occurs before the mass has acquired any great magnitude, when it now forms irregular sloughs, or ulcerates and sloughs in different places; has everted irregular hard edges, with a violaceous coloured inflammation around; and the discharge is thin, dirty green, and ichorous. The axillary glands are commonly affected im mediately after the disease becomes occult cancer, and they soon afterwards contaminate those under the clavicle and in the neck; and even all the subcutaneous, for it is a mistaken idea to sup pose that ulceration must precede the contam ination of the axillary glands. The affection now becomes constitutional, extending to the glandular system of the thorax and abdomen, and even to the pleura costalis and ribs; but by some authors these constitutional symptoms are supposed to take place at an earlier period. When the constitution is affected, the patient feels pains darting along the spine, and has cough with diffi culty of breathing. This species commonly begins in a small spot at the nipple, and extends around in all directions like the radii of a circle, ultimately involving the whole mammary gland, the skin, the cellular substance, the muscles, the lymphatic glands, &c., for there seems no disposition to this
horrible disease in the surrounding parts prior to the actual carcinomatous action. In some rare instances this disease is sacculated. When the tumour after removal is bisected, it presents a hardened glistening appearance, with firm white bands intersecting it in all directions, either like radii or irregular bands, or in an arborescent man ner; the whole very much resembles cartilage. This species generally attacks the female when the catamenia cease, between forty and fifty years of age, but occurs occasionally at its first appearance, when the pains are aggravated at every period of menstruation. It may be produced at any period of life by a blow, or succeed mammary inflamma tion and abscess. This species of tumour may be attempted to be discussed by the repeated ap plication of leeches, especially when the catamenia are expected to take place, and by anodyne fomenta tions, poultices, low diet, and gentle exercise; and when pain has been subdued, by local pressure. But the tediousness and anxiety are such, that most patients demand an operation, which, without doubt, is the safest.
The patient should be laid on a table, and the arm of the affected side elevated towards the head with the hand supinated; two semi-elliptical in cisions are to be made from the axilla to the sternum, so as to include all diseased skin, and to leave if possible enough to cover the wound, and the lower or sacral made first. These in cisions should extend through the skin and cellular substance to the fascia of the muscle, dissecting the lower from the gland first, and defining clearly both angles. A few sweeps of the scalpel from above downwards will remove the whole gland, all of which ought to be invariably extirpated. Sometimes the muscle itself is affected to a con siderable extent and requires removal. During the removal of the tumour, an assistant should put his fingers on the bleeding arteries, which ought now to be secured. The edges of the wound are then approximated either with ligatures or ad hesive straps, according to the deficiency of the integuments; compresses of lint, together with a roller around the trunk, supported by two shoulder straps or braces are lastly applied. If there have been many small arteries wounded, and not all secured, a second roller should be applied, and tighter than the first, and which must be removed in a few hours, for whenever re-action takes place, respiration becomes affected. The wound to be dressed on the third or fourth day. When the axillary glands are diseased, one of the external incisions should extend over them at the outset of the operation; but they ought not to be cut out till the removal of the mammary gland, and the knife should run parallel with the axillary vein, with its back to the vessel. Whenever an artery springs in this region it ought to be secured; and even if a vein bleed freely, a ligature must be thrown around its mouth. There is a cutaneous variety of cancer which attacks both the male and female promiscuously.